Medicare Biller/Collector in Santa Fe Springs, CA at Pipeline Health

Date Posted: 1/9/2023

Job Snapshot

Job Description

Essential Job Duties:  

  • Knows how to download Medicare claims in billing system daily or as needed.
  • Monitors & processes credit balances for refunds and transfers in accordance with department procedures.
  • Processes daily bills via Change Healthcare/Assurance, SSI and or Medicare DDE system if needed.
  • Process claims and bills to payors through bill editor in accordance with department procedures.
  • Knowledge in printing the Remittance Advices
  • Works on denial accounts daily or as needed.
  • Works on daily rejection daily or as needed.
  • Works on daily mail and correspondence.
  • Responsible for working off the work ques and clearing ticklers efficiently.

  • Maintains quality control on all accounts for correct plan ID’s and financial class.  Updates system with appropriate changes.

  • Sends requests to ancillary departments for reports needed to bill claims in a timely manner.

  • Responsible to keep current with updates and changes within the Medicare via CMS website.

  • Responsible to retrieve any patient information from the OneContent in Paragon for LA Market and or Power Chart in Cerner for Dallas and Chicago Facilities

  • Processes daily contractual adjustments. & calculates payment and contractual adjustment according to expected reimbursement.
  • Works and resolves aged accounts.
  • Identifies under and over payments.
  • Ensures each account has detailed documentation as required by the department procedures.
  • Meets productivity requirements on a daily basis.
  • Provides Medicare RA’s to cross over biller.
  • Prepares credit balance reporting every quarter to Medicare.
  • Demonstrates ability to reach decisions takes appropriate action and follow through within scope of responsibility, as defined by job description.
  • Processes secondary billing and transfers in accordance with department procedures.
  •  Additional duties and projects as assigned.

Behavioral Standards: 

  • Exhibits customer and service oriented behaviors in every day work interactions.

  • Demonstrates a courteous and respectful attitude to internal workforce and external customers.

  • Communicates accurately and appropriately.

  • Works well and efficiently under minimal supervision.

  • Handles difficult situations in a discreet and professional manner.

  • Is adaptable to changes in assignments and priorities.

Communication/Knowledge:

  • Provides accurate and timely written and verbal communication of information in a manner that is understood by all.  

  • Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.

  • Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

  • Contributes toward effective, positive working relationships with internal and external colleagues.

  • Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.

Education/Experience:

  • High school graduate or equivalent required

  • Prefer at least 2 to 3 years of current experience in an acute care hospital setting

  • Computer skills preferred

Licensure/Certifications:

  • N/A

ADA/Physical Demands:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.

  • Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell.  The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.